The certificate of acknowledgment mentioned in the preceding
section may be in form or effect as follows:

State (territory or district) of ................., county of
.........................., to wit:

I, ........., recorder of said municipality; or I,
.............., a notary public of said county; or I,
............., a clerk of the ................... court of said
county; (or other officer or person authorized to take
acknowledgments by section three of this article, as the case may
be), do certify that ..........................., whose name (or
names) is (or are) signed to the writing above (or hereto annexed)
bearing date on the .......... day of ................, 20
........., has (or have) this day acknowledged the same before me,
in my said .....................